title: Altered cerebral blood flow patterns associated with pathologic worry in the elderly.
abstract: BACKGROUND
  Generalized anxiety disorder (GAD) is the most prevalent anxiety disorder among the elderly and has high functional and cognitive morbidity. However, late-life GAD is relatively understudied and its functional neuroanatomy is uncharted. Several imaging studies have suggested abnormalities in the cognitive control systems of emotion regulation in anxiety disorders in young adults. The aim of this study was to examine the neural correlates of emotion regulation in late-life GAD.
  
  
  METHODS
  We compared 7 elderly GAD subjects and 10 elderly nonanxious comparison subjects using functional MRI. Regional cerebral blood flow (rCBF) was measured using pulsed arterial spin labeling perfusion MRI at rest and during an emotion regulation paradigm.
  
  
  RESULTS
  Relative to the rest condition, elderly nonanxious comparison subjects had increased rCBF during worry induction (WI) in the right insula, bilateral amygdala, and associative temporooccipital areas. Elderly GAD subjects had increased rCBF during WI in the associative temporooccipital areas, but not in the insula or the amygdala. During worry suppression (WS), elderly nonanxious comparison subjects had increased rCBF in the prefrontal cortex (PFC) and dorsal ACC. Elderly GAD subjects had no changes in rCBF during WS in the PFC.
  
  
  CONCLUSIONS
  When attempting to regulate their emotional responses, elderly anxious subjects failed to activate prefrontal regions involved in the downregulation of negative emotions. These results, showing that elderly anxious subjects are not effectively engaging the PFC in suppressing worry, may be clinically relevant for developing personalized therapeutic strategies for the treatment of late-life GAD.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic,3811 O’Hara Street, Pittsburgh, PA, USA. Andreescuc@upmc.edu
authors.forename: Carmen
authors.initials: C
authors.lastname: Andreescu
authors.forename: James J
authors.initials: JJ
authors.lastname: Gross
authors.forename: Eric
authors.initials: E
authors.lastname: Lenze
authors.forename: Kathryn Dunfee
authors.initials: KD
authors.lastname: Edelman
authors.forename: Sara
authors.initials: S
authors.lastname: Snyder
authors.forename: Costin
authors.initials: C
authors.lastname: Tanase
authors.forename: Howard
authors.initials: H
authors.lastname: Aizenstein
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology*; D000368:Aged; D000679:Amygdala / Q000098:blood supply; D001008:Anxiety Disorders / Q000175:diagnosis / Q000503:physiopathology*; D001143:Arousal / Q000502:physiology; D001921:Brain / Q000098:blood supply*; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000098:blood supply; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology; D004292:Dominance, Cerebral / Q000502:physiology; D015536:Down-Regulation / Q000502:physiology; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009778:Occipital Lobe / Q000098:blood supply; D017397:Prefrontal Cortex / Q000098:blood supply; D012016:Reference Values; D012039:Regional Blood Flow / Q000502:physiology; D013702:Temporal Lobe / Q000098:blood supply